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Grieving the Loss of the Symptom

As a therapist who works with people with eating disorders, I am regularly exposed to the tremendous angst and confusion people feel when wrestling with the possibility of recovery. It is no mystery that this process is a difficult one, a journey that can be fraught with back and forth, yes and no, “I guess recovery is worth it but maybe it’s not”. Patients often speak of the great cost it would be to give up their eating disorder. There is a feeling that recovery entails the loss of something dear. On the other hand, I have also talked a lot with patients about what they miss from their life without their eating disorder, what they’d hope to regain, and what they’ll miss out on if they continue acting through their symptoms. Time and again, patients respond with creative and inspired dreams for themselves, but there is doubt that these dreams will be realized if they remain committed to their eating disorder. They are aware of the great cost of their eating disorder, yet this knowledge is rarely enough to allow them to whole-heartedly choose recovery.

I think there are many reasons for this, but I’d like to focus on one that I’ve wondered about recently. I stumbled upon this idea when I was in a training class about how to work with dreams in psychotherapy. There are many theories about dreams that are out there, with perhaps the most famous being Freud’s theory that all dreams display, in disguised form, an unconscious wish. More recently, the interplay between psychoanalysis and neurobiology has been explored and one theorist, Mark Blechner, proposes a theory about dreams that seems quite salient when working with eating disorder patients. Blechner suggests the idea that “Dreams may express things that are not expressible by any other means” which is to say that dreams are their own language. Blechner encourages the therapist to think about how dreams express things from the patient’s mind that couldn’t be fully stated or understood with words. Dreams themselves are the language, and they aren’t comprised of syntax and sentence structure, and when we try to understand dreams through words, they lose some of their meaning. Speaking the dream requires that the dreamer squeeze a multilayered, multidimensional concept through the confining constraints of a series of words. There’s a loss involved.

There is a parallel, it seems, between this understanding of dreams and how we might understand a patient’s eating disorder symptoms. Like the dream, when we try to understand the meaning of the symptom through words, the symptom loses its perfection, its completeness, and its mystique. Therapists and patients together might conceptualize the symptom as meaning x, y, and z. For example, restricting one’s food intake could signify the expression of one’s anger, one’s loss of self, and one’s need for independence, and usually much more, all at the same time. And all of that would be true. Through the laconic nature of a symptom, a complexity is wrapped up into one nice, neat behavior. The language of the symptom is brimming with action, affect, metaphor, thought, memory, or even trauma—all of which makes the symptom extremely powerful. The symptom is saying the unsayable, not necessarily because all of that can’t be said (though in some cases, like with trauma, that is the case), but because all of that can’t be said at the same time without missing some of the meaning.

It’s important to think about the contribution of therapy to this reduction of meaning. In therapy, the patient begins the process of giving structured meaning, through words, to the symptom. Inevitably, a reduction occurs. When the patient chooses to not act on their eating disorder, but talk about it instead in therapy, they lose the symptom’s powerful language, which is also to lose the mysterious, elusive, symbolic, controlling, and silent nature of the symptom. Like dreams, speaking in words is not the primary language of the symptom. Any verbalization of the meaning of the symptom is a translation, and it’s a translation that can force mediocrity. Something is lost.

This is one reason why I think the addition of other types of therapy, not just talk therapy, can be so beneficial to the process of healing that occurs in recovery from an eating disorder. Non-verbal forms of therapy, such as art, dance, or music, provide an excellent forum for this complexity to be communicated in other ways than through the symptom. But I also think that this loss of meaning is something that us “talk therapists” should try to be keenly aware of. When a patient chooses recovery, there is an entirely new world to be gained, but there is also loss. When we think of recovery, it can be easy to envision the positive—the possibilities, the health, the connection to one’s self and to others. But when a symptom as powerful as not eating, for example, is forgone, in a sense, the patient is losing a language, which is to say she’ll be losing a treasured part of herself. She knows herself through this language. She understands the world through this language. It would be quite strange if she were not ambivalent about giving this up.

Recovery from an eating disorder is a long and involved process and it is nothing new to say that grief is a part of this process. What I’ve considered here is the grief that may need to be processed around the loss of the language of the symptom and what that means for the patient’s commitment to therapy and to recovery. Perhaps if this loss of language, and all that goes with it, is understood, named, and worked through, the patient might be more able to look for other, more adaptive ways, of communicating her complexities to herself and to the world.

McCallum Place is a nationally recognized, comprehensive eating disorder treatment center for adolescents and adults. The facility was founded in St. Louis and has opened an additional center in the Greater Kansas City area. Each clinic offers on-site medical and psychiatric management combined with intensive, individualized psychotherapy. McCallum Place’s eating disorder treatment programs provide a continuum of care, specialized to provide the right level of support to optimize recovery for each patient.

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McCallum Place is a nationally acclaimed, comprehensive eating disorder treatment center offering residential and partial hospitalization program services. With locations in Kansas City and St Louis, we offer evidence-based psychological, nutritional and medical care for women and men beginning at age 10.